Thrombosis in breast cancer patients on cyclin-dependent kinase inhibitors: Survival impact and predictive factors - A study by the cancer and thrombosis group of the spanish society of medical oncology (SEOM).

Thrombosis may be included in the profile of side effects associated with CDK4/6 inhibitors. Its significance might be greater than reported in randomized clinical trials. To investigate this, a retrospective, multicenter study was conducted. The primary objective was to calculate the incidence of thrombosis associated with CDK4/6 inhibitors. Secondary objectives included examining the impact of thrombosis on survival and identifying predictor variables for the development of venous thromboembolism (VTE) or arterial thrombosis (AT). A total of 986 patients were recruited. The incidence of VTE/AT associated with CDK4/6 inhibitor treatment during the follow-up period was 5.48 %. Survival analysis did not indicate that the development of VTE/AT during CDK4/6 inhibitor treatment significantly impacted patient survival (p = 0.133). In our analysis, two variables were found to be statistically significant (p < 0.05) as predictors of VTE/AT in breast cancer patients receiving CDK4/6 inhibitor therapy. These variables were the presence of central nervous system (CNS) metastasis with an odds ratio (OR) of 3.68 (95 % CI 1.18 - 11.49) and the use of abemaciclib with an OR of 2.3 (95 % CI 1.16 - 4.57).

Comparison of Clinical and Genetic Characteristics Between Younger and Older Lung Cancer Patients.

INTRODUCTION: The aim of this study was to analyze the clinical and genetic characteristics of young lung cancer cases, and to compare them with those of older cases. METHODS: We used the Thoracic Tumors Registry (TTR) as a data source representative of lung cancer cases diagnosed in Spain, and included all cases registered until 9/01/2023 which had information on age at diagnosis or the data needed to calculate it. We performed a descriptive statistical analysis and fitted logistic regressions to analyze how different characteristics influenced being a younger lung cancer patient. RESULTS: A total of 26,336 subjects were included. Lung cancer cases <50 years old had a higher probability of being women (OR: 1.38; 95% CI: 1.21-1.57), being in stage III or IV (OR: 1.32; 95% CI: 1.08-1.62), not having comorbidities (OR: 5.21; 95% CI: 4.59-5.91), presenting with symptoms at diagnosis (OR: 1.53; 95% CI: 1.29-1.81), and having ALK translocation (OR: 7.61; 95% CI: 1.25-46.32) and HER2 mutation (OR: 5.71; 95% CI: 1.34-24.33), compared with subjects ≥50 years. Among subjects <35 years old (n=61), our study observed a higher proportion of women (59.0% vs. 26.6%; p<0.001), never smokers (45.8% vs. 10.3%; p<0.001), no comorbidities (21.3% vs. 74.0%; p<0.001); ALK translocation (33.3% vs. 4.4%; p<0.001) and ROS1 mutation (14.3% vs. 2.3%; p=0.01), compared with subjects ≥35 years. CONCLUSIONS: Lung cancer displays differences by age at diagnosis which may have important implications for its clinical management.

Immune checkpoint inhibitor-associated thrombosis in patients with bladder and kidney cancer: a study of the Spanish Society of Medical Oncology (SEOM) thrombosis and cancer group

Purpose Both venous and arterial thrombotic events (VTE/AT) can be associated with immune checkpoint inhibitors (ICI). However, there is a paucity of information apropos patients in routine clinical practice. Methods/patients Retrospective, multicenter study promoted by the Thrombosis and Cancer Section of the Spanish Society of Medical Oncology (SEOM). Individuals with kidney or bladder cancer who initiated ICI between 01/01/2015 and 12/31/2020 were recruited. Minimum follow-up was 6 months (except in cases of demise). The primary objective was to calculate the incidence of ICI-associated VTE/AT and secondary objectives included to analyze their impact on survival and identify variables predictive of VTE/AT. Results 210 patients with kidney cancer were enrolled. The incidence of VTE/AT during follow-up (median 13 months) was 5.7%. Median overall survival (OS) was relatively lower among subjects with VTE/AT (16 months, 95% CI 0.01–34.2 vs. 27 months, 95% CI 22.6–31.4; p = 0.43). Multivariate analysis failed to reveal predictive variables for developing VTE/ AT. 197 patients with bladder were enrolled. There was a 9.1% incidence rate of VTE/AT during follow-up (median 8 months). Median OS was somewhat higher in patients with VTE/AT (28 months, 95% CI 18.4–37.6 vs 25 months, 95% CI 20.7–29.3; p = 0.821). Serum albumin levels < 3.5 g/dl were predictive of VTE/ AT (p < 0.05). Conclusions There appears to be no association between developing VTE/AT and ICI use in patients with renal or bladder cancer. Serum albumin levels are a predictive factor in individuals with bladder cancer (AU)

Immune checkpoint inhibitor-associated thrombosis in patients with bladder and kidney cancer: a study of the Spanish Society of Medical Oncology (SEOM) thrombosis and cancer group.

PURPOSE: Both venous and arterial thrombotic events (VTE/AT) can be associated with immune checkpoint inhibitors (ICI). However, there is a paucity of information apropos patients in routine clinical practice. METHODS/PATIENTS: Retrospective, multicenter study promoted by the Thrombosis and Cancer Section of the Spanish Society of Medical Oncology (SEOM). Individuals with kidney or bladder cancer who initiated ICI between 01/01/2015 and 12/31/2020 were recruited. Minimum follow-up was 6 months (except in cases of demise). The primary objective was to calculate the incidence of ICI-associated VTE/AT and secondary objectives included to analyze their impact on survival and identify variables predictive of VTE/AT. RESULTS: 210 patients with kidney cancer were enrolled. The incidence of VTE/AT during follow-up (median 13 months) was 5.7%. Median overall survival (OS) was relatively lower among subjects with VTE/AT (16 months, 95% CI 0.01-34.2 vs. 27 months, 95% CI 22.6-31.4; p = 0.43). Multivariate analysis failed to reveal predictive variables for developing VTE/ AT. 197 patients with bladder were enrolled. There was a 9.1% incidence rate of VTE/AT during follow-up (median 8 months). Median OS was somewhat higher in patients with VTE/AT (28 months, 95% CI 18.4-37.6 vs 25 months, 95% CI 20.7-29.3; p = 0.821). Serum albumin levels < 3.5 g/dl were predictive of VTE/ AT (p < 0.05). CONCLUSIONS: There appears to be no association between developing VTE/AT and ICI use in patients with renal or bladder cancer. Serum albumin levels are a predictive factor in individuals with bladder cancer.

Emerging Blood-Based Biomarkers for Predicting Immunotherapy Response in NSCLC.

Immunotherapy with Immune Checkpoint Inhibitors (ICIs) has demonstrated a profitable performance for Non-Small Cell Lung Cancer (NSCLC) cancer treatment in some patients; however, there is still a percentage of patients in whom immunotherapy does not provide the desired results regarding beneficial outcomes. Therefore, obtaining predictive biomarkers for ICI response will improve the treatment management in clinical practice. In this sense, liquid biopsy appears as a promising method to obtain samples in a minimally invasive and non-biased way. In spite of its evident potential, the use of these circulating biomarkers is still very limited in the real clinical practice, mainly due to the huge heterogeneity among the techniques, the lack of consensus, and the limited number of patients included in these previous studies. In this work, we review the pros and cons of the different proposed biomarkers, such as soluble PD-L1, circulating non-coding RNA, circulating immune cells, peripheral blood cytokines, and ctDNA, obtained from liquid biopsy to predict response to ICI treatment at baseline and to monitor changes in tumor and tumor microenvironment during the course of the treatment in NSCLC patients.

Prevalencia y caracterización del dolor irruptivo oncológico en pacientes hospitalizados en Vigo. Estudio Dolopaho / Prevalence and characterization of breakthough cancer pain in hospitalized patients in Vigo. The Dolopaho study

Introducción: El dolor sigue siendo en la actualidad un problema no resuelto en los pacientes con cáncer. A pesar de los avances en el tratamiento del dolor en los últimos años, persisten lagunas que dificultan un tratamiento global, como es el caso del dolor irruptivo oncológico (DIO). Objetivos: Evaluar la prevalencia de DIO de una muestra de pacientes ingresados en un servicio de oncología médica, analizar si el dolor era el principal motivo de ingreso en estos pacientes, así como determinar si existe un infradiagnóstico y, por tanto, un infratratamiento en los mismos previamente al ingreso. Métodos: Estudio observacional prospectivo. Se reclutaron los pacientes de forma consecutiva, independientemente del motivo de ingreso. Las variables analizadas en relación con el dolor irruptivo fueron las siguientes: presencia de dolor irruptivo según el algoritmo de Davies; semejanza de los episodios de dolor irruptivo entre sí y respecto al dolor basal; número de crisis de dolor a lo largo del día y a lo largo de la semana; escala visual analógica del dolor irruptivo; tiempo desde el inicio del dolor hasta su máxima intensidad medida en los siguientes rangos: < 5 min, 5-30 min, > 30 min; la duración de los episodios: < 5 min, 5-30 min, > 30 min; desencadenantes del dolor irruptivo (incidental, espontáneo); percepción individual de la alteración en la calidad de vida y efectividad de los fármacos utilizados. Resultados: Se incluyeron un total de 115 pacientes. En la muestra analizada el 33,9 % de los pacientes presentaron dolor irruptivo, de ellos el 95 % recibían tratamiento con opioides mayores, pero en solo el 56 % de los casos se asociaron a opioides de liberación ultrarrápida. Conclusión: El manejo de los pacientes con DIO continúa siendo un reto a día de hoy. Cerca de la mitad de los pacientes con dolor irruptivo no habían recibido tratamiento adecuado en nuestro estudio y, por tanto, probablemente no estaban bien caracterizados. (AU)

Background: Pain is often inadequately treated in patients with cancer. Although in recent years there have been major advances in the treatment of pain, there are still gaps for a global treatment, such as breakthrouth cancer pain (BCP). Objectives: The main objective was to evaluate the prevalence of BCP in a sample of patients admitted to a oncology medical department, in order to see whether pain is the main reason for admission in these patients, as well as to determine whether they were correctly treated and diagnosed before admission. Methods: An observational, prospective study. Patients were enrolled consecutively, regardless of reason for admission. The variables analyzed in relation to breakthrough pain were the following: presence of breakthrough pain according to the Davies scale; similarities of breakthrough pain events to each other and to baseline pain; number of irruptive pain events throughout the day and throughout the week; visual analogue scale of breakthrough pain; time between the onset of breakthrough pain and maximum intensity as measured in the following ranges: < 5 minutes, 5-30 minutes, > 30 minutes; duration of the breakthrough pain event (< 5 minutes, 5-30 minutes, > 30 minutes); triggers of breakthrough pain (incidental, spontaneous); perceived quality of life impairment and effectiveness of the drugs used. Results: A total of 115 patients consecutively admitted were analyzed regardless of reason for admission. In the analyzed sample, 33.9 % of patients had breakthrouth pain, and 95 % of the patients with breakthrough pain received treatment with strong opioids, though only in 56.4 % of cases associated with ultra-rapid-release opioids.Conclusions: The management of BCP is still a challenge. About half of patients with breakthrough cancer pain had not received adecuated treatment in our study, and were therefore poorly diagnosed. (AU)

Cognitive performance in patients with episodic cluster headache outside and inside the active cluster.

BACKGROUND: Previous studies have shown worse cognitive performance in cluster headache (CH) patients compared to healthy controls; however, little is known about cognitive performance in episodic CH (ECH) patients outside and inside the active cluster (AC). OBJECTIVE: Our aim is to compare cognitive function in ECH patients outside and inside the AC. METHODS: In this cross-sectional, observational study, four neuropsychological tests (Trail Making Test [TMT], Stroop Test [ST], verbal fluency [VF], and Symbol Digit Modalities Test [SDT]) were completed by 21 ECH patients at two different points in time: outside and inside the AC. We also assessed self-reported sleep quality and the presence of anxiety or depressive symptoms. Scores were compared. RESULTS: There was not any difference between the scores of the neuropsychological tests performed outside and inside the AC (TMT-A: 23 vs. 23.5; p = 0.984; TMT-B: 96.5 vs. 85.9; p = 0.104; ST word reading: 101.0 vs. 101.2; p = 0.938; ST color naming: 73.0 vs. 73.4; p = 0.858; ST color word: 44.0 vs. 46.0; p = 0.498; SDMT: 44.0 vs. 44.6; p = 0.961; VF phonemic: 29.5 vs. 30.2; p = 0.714; VF semantic: 20 vs. 21; p = 0.489). We found a worsening in the sleep quality component of the Pittsburgh Sleep Quality Index median scores in patients outside the AC (2 vs. 1; p = 0.046). CONCLUSIONS: Our findings suggest that patients with ECH have a similar cognitive performance outside and during the AC.

Cognitive Performance in Episodic Cluster Headache.

BACKGROUND: Cluster headache is one of the most disabling of all headache conditions. Although some studies have investigated the psychological profile of patients with cluster headache, research on its impact on cognitive function in patients with episodic cluster headache outside the cluster bout is scant. METHODS: Cross-sectional study to evaluate various aspects of neuropsychological assessment and cognitive function including working memory, selective attention, verbal fluency, and executive function in 40 patients with episodic cluster headache. The patients were compared with 40 age-, gender-, and level of education-matched healthy controls. RESULTS: Episodic cluster headache patients performed significantly worse than healthy controls on all cognitive tests, except for the Interference Score (P = 0.281). They had significantly higher Hospital Anxiety Scale scores (P = 0.002). However, we found no significant association between cognitive performance, anxiety, sleep quality, and disease duration. CONCLUSIONS: Patients with episodic cluster headache outside the bout showed worse executive functioning, working memory, language, and selective attention compared with healthy controls, regardless of the duration of disease or sleep quality.

Lacosamida asociada a bloqueo de alto grado en un paciente con neuralgia del trigémino / Lacosamide associated with high-degree block in a patient with trigeminal neuralgia

Introducción. La lacosamida es un fármaco antiepiléptico cuyo mecanismo de acción exacto se desconoce. Actúa aumentando la inactivación lenta de los canales de sodio dependientes del voltaje de las membranas celulares. Indicado en el tratamiento de crisis focales con o sin generalización secundaria, ocasionalmente se emplea como tratamiento coadyuvante en el dolor neuropático. Aunque los efectos adversos más frecuentes son leves (mareo, diplopía, visión borrosa, cefalea, temblor...), se han descrito taquiarritmias supraventriculares, cambios en la repolarización, bloqueos auriculoventriculares e incluso parada cardíaca o muerte súbita. Caso clínico. Varón de 74 años, diagnosticado de neuralgia del trigémino clásica en tratamiento con 200 mg/12 h de carbamacepina, que acude por reagudización del dolor en el territorio trigeminal V1-V2. El sexto día de ingreso, tras ajustar el tratamiento con carbamacepina en pauta descendente, 400 mg/24 h de eslicarbacepina y 100 mg/12 h de lacosamida intravenosa, presenta bloqueo auriculoventricular completo con bradicardia extrema que precisa la implantación de un marcapasos definitivo. Conclusiones. El bloqueo de canales de sodio dependientes del voltaje afecta predominantemente al tejido cardíaco no sinusal. Una alteración en el nodo auriculoventricular o infrahisiano es más congruente con su mecanismo de acción. Existen más casos comunicados de bloqueo auriculoventricular en este tipo de politerapia. Se recomienda precaución en el uso concomitante de fármacos antiepilépticos, sobre todo entre los que prolonguen el intervalo PR, así como su contraindicación en pacientes con antecedentes de bloqueo auriculoventricular, cardiopatía isquémica o insuficiencia cardíaca. Antes de su inicio, se aconseja realizar un electrocardiograma basal y monitorización electrocardiográfica regular durante las primeras semanas (AU)

Introduction. Lacosamide is an antiepileptic drug whose exact mechanism of action remains unknown. It acts by increasing the slow inactivation of the voltage-dependent sodium channels of the cell membranes. It is indicated in the treatment of focal seizures with or without secondary generalisation and is occasionally used as adjunct treatment in neuropathic pain. Although the most frequent side effects are mild (dizziness, diplopia, blurred vision, headache, tremor, etc.), others such as supraventricular tachyarrhythmias, changes in repolarisation, atrioventricular blocks and even cardiac arrest or sudden death have been reported. Case report. A 74-year-old male, diagnosed with classic trigeminal neuralgia treated with 200 mg/12 h of carbamazepine, who visited due to a worsening of the pain in the trigeminal V1-V2 region. On the sixth day after admission, after adjusting the carbamazepine treatment to a descending regime, 400 mg/24 h of eslicarbazepine and 100 mg/12 h of intravenous lacosamide, he presented a complete atrioventricular block with extreme bradycardia that required the placement of a pacemaker. Conclusions. Voltage-dependent sodium channel blockade mainly affects non-sinusal cardiac tissue. An alteration in the atrioventricular or infrahisian node is more consistent with its mechanism of action. Other cases of atrioventricular block in this kind of polytherapy have been reported. Precaution is advised in the concomitant use of antiepileptic drugs, above all among those that prolong the PR interval, and they should be contraindicated in patients with a history of atrioventricular block, ischaemic heart disease or heart failure. Before starting, a baseline electrocardiogram and regular electrocardiographic monitoring are advised during the first few weeks (AU)